Pediatric extubation readiness tests should not use pressure support

Robinder G. Khemani*, Justin Hotz, Rica Morzov, Rutger C. Flink, Asvari Kamerkar, Marie LaFortune, Gerrard F. Rafferty, Patrick A. Ross, Christopher J L Newth

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

65 Citations (Scopus)
367 Downloads (Pure)


Purpose: Pressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH2O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support. Methods: Prospective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH2O, CPAP 5 cmH2O (CPAP), and spontaneous breathing 5 and 60 min post-extubation. Subgroup analysis excluded post-extubation upper airway obstruction (UAO) and stratified by endotracheal tube size and post-extubation noninvasive respiratory support. Results: We included 409 children. Pressure rate product on pressure support [100 (IQR 60, 175)] was lower than CPAP [200 (120, 300)], which was lower than 5 min [300 (150, 500)] and 60 min [255 (175, 400)] post-extubation (all p 

Original languageEnglish
Pages (from-to)1214-1222
Number of pages9
JournalIntensive Care Medicine
Issue number8
Early online date18 Jun 2016
Publication statusPublished - 1 Aug 2016


  • Airway extubation
  • Pediatrics
  • Ventilator weaning
  • Work of breathing


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